Burns and scalds

Introduction

Burns and scalds are damage to the skin caused by heat. Both are treated in the same way.
A burn is caused by dry heat, from an iron or fire for example. A scald is caused by
something wet, such as hot water or steam.
Burns can be very painful and can cause blisters and charred, black or red skin.
Read more information about the symptoms of burns and scalds, including the different types
of burn.
Treating burns and scalds
To treat a burn, follow the first aid advice below:
Immediately get the person away from the heat source to stop the burning.
Cool the burn with cool or lukewarm water for 10 to 30 minutes. Do not use ice, iced
water or any creams or greasy substances, such as butter.
Remove any clothing or jewellery that is near the burnt area of skin, but do
not move anything that is stuck to the skin.
Make sure the person keeps warm for example by using a blanket but take care
not to rub it against the burnt area.
Cover the burn by placing a layer of cling film over it.
Use painkillers, such as paracetamol or ibuprofen, to treat any pain.
Read more about treating burns and scalds.
When to get medical attention
Depending on how serious a burn is, it may be possible to treat it at home. For minor burns,
keep the burn clean and do not burst any blisters that form.
More serious burns will require professional medical attention. You should go to a hospital
A&E department for:
all chemical and electrical burns
large or deep burns any burn bigger than your hand
full thickness burns of all sizes these burns cause white or charred skin
partial thickness burns on the face, hands, arms, feet, legs or genitals these are burns
that cause blisters
If someone has breathed in smoke or fumes, they should also seek medical attention. Some
symptoms may be delayed and can include coughing, a sore throat, difficulty breathing or
facial burns.
People who are at greater risk from the effects of burns, such as children under five years old
and pregnant women, should also get medical attention after a burn or scald.
The size and depth of the burn will be assessed and the affected area cleaned before a
dressing is applied. In severe cases, skin graft surgery may be recommended.
Read more information about recovering from burns and scalds.
Preventing burns and scalds
Many severe burns and scalds affect babies and young children. Examples of things you can
do to help reduce the chances of your child having a serious accident at home include:
keeping your child out of the kitchen whenever possible
testing the temperature of bath water using your elbow before you put your baby or
toddler in the bath
keeping matches, lighters and lit candles out of young children's sight and reach
keeping hot drinks well away from young children
If you need advice about a burn, you can:
call NHS Direct Wales on 0845 4647
go to a minor injuries unit (MIU)
call or see your GP
Use the local services to find minor injury units near you.
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Symptoms
The symptoms of a burn or scald will vary depending on how serious it is. Some minor burns
can be very painful, while some major burns may not hurt at all.
Symptoms of a burn may include:
red skin
peeling skin
blisters
swelling
white or charred skin
The amount of pain you feel is not always related to how serious the burn is.
Your skin
Your skin is your bodys largest organ. It has many functions, including acting as a barrier
between you and the environment and regulating your temperature. Your skin is made up of
three layers:
The epidermis (the outer layer of your skin) is 0.51.5mm thick. It has five layers of
cells that work their way up to the surface of your skin, where dead cells are shed
approximately every two weeks.
The dermis (the underlying layer of fibrous tissue) is 0.33mm thick and is made up
of a mix of three types of tissue. The dermis contains your hair follicles and sweat
glands, as well as small blood vessels and nerves.
The subcutaneous fat or subcutis (the final layer of fat and tissue) varies in thickness
from person to person. It contains your larger blood vessels and nerves, and regulates
the temperature of your skin and body.
Types of burn
Burns are assessed by how seriously your skin is damaged. There are four main types of burn,
which tend to have a different appearance and different symptoms:
superficial epidermal burns
superficial dermal burns
deep dermal or partial thickness burns
full thickness burns
These are described in more detail below.
Superficial epidermal burns
Superficial epidermal burns are where the epidermis is damaged. Your skin will be red,
slightly swollen and painful but not blistered.
Superficial dermal burns
Superficial dermal burns are where the epidermis and part of the dermis are damaged. Your
skin will be pale pink, painful and there may be small blisters.
Deep dermal or partial thickness burns
Deep dermal or partial thickness burns are where the epidermis and the dermis are damaged.
This type of burn makes your skin turn red and blotchy. Your skin may also be dry or moist,
become swollen and blistered, and it may be very painful or painless.
Full thickness burns
Full thickness burns are where all three layers of skin (the epidermis, dermis and subcutis) are
damaged. In this type of burn, the skin is often burnt away and the tissue underneath may
appear pale or blackened. The remaining skin will be dry and white, brown or black with no
blisters. The texture of the skin may also be leathery or waxy.
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Treatment
Appropriate first aid must be used to treat any burns or scalds as soon as possible. This will
limit the amount of damage to your skin.
You may need to apply the following first aid techniques to yourself or to another person who
has been burnt.
First aid for burns
Follow the first aid advice below to treat burns and scalds:
Stop the burning process as soon as possible. This may mean removing the person
from the area, dousing flames with water or smothering flames with a blanket. Do not
put yourself at risk of getting burnt as well.
Remove any clothing or jewellery near the burnt area of skin. However, don't try to
remove anything that is stuck to the burnt skin because this could cause more damage.
Cool the burn with cool or lukewarm water for 1030 minutes, ideally within 20
minutes of the injury occurring. Never use ice, iced water or any creams or greasy
substances, such as butter.
Keep yourself or the person warm. Use a blanket or layers of clothing, but
avoid putting them on the injured area. Keeping warm will prevent hypothermia,
when a persons body temperature drops below 35C (95F). This is a risk if you are
cooling a large burnt area, particularly in young children and elderly people.
Cover the burn with cling film. Put the cling film in a layer over the burn, rather
than wrapping it around a limb. A clean, clear plastic bag can be used for burns on
your hand.
Treat the pain from a burn with paracetamol or ibuprofen. Always check the
manufacturers instructions when using over-the-counter (OTC) medication. Children
under 16 years of age should not be given aspirin.
When to go to hospital
Once you have taken these steps, you will need to decide whether further medical treatment is
necessary. Go to a hospital accident and emergency (A&E) department for:
all chemical and electrical burns (see below)
large or deep burns any burn bigger than the affected persons hand
full thickness burns of all sizes these burns cause white or charred skin
partial thickness burns on the face, hands, arms, feet, legs or genitals these are burns
that cause blisters
Also get medical help straight away if the person with the burn:
has other injuries that need treating or is going into shock (signs include cold, clammy
skin, sweating, rapid, shallow breathing and weakness or dizziness)
is pregnant
is over 60 years of age
is under five years of age
has a medical condition such as heart, lung or liver disease, or diabetes (a long-term
condition caused by too much glucose in the blood)
has a weakened immune system (the bodys defence system), for example because of
HIV or AIDS or because they're having chemotherapy for cancer
If someone has breathed in smoke or fumes, they should also seek medical attention. Some
symptoms may be delayed and can include coughing, a sore throat, difficulty breathing,
singed nasal hair or facial burns.
Read more about recovering from burns and scalds for information on how serious burns are
treated.
Electrical burns
Electrical burns may not look serious, but they can be very damaging. Someone who has an
electrical burn should seek immediate medical attention at an A&E department.
If the person has been injured by a low-voltage source (up to 220240 volts) such as a
domestic electricity supply, safely switch off the power supply or remove the person from the
electrical source using a non-conductive material. This is a material that does not conduct
electricity, such as a wooden stick or a wooden chair.
Do not approach a person who is connected to a high-voltage source (1,000 volts or more).
Chemical burns
Chemical burns can be very damaging and require immediate medical attention at an A&E
department.
If possible, find out what chemical caused the burn and tell the healthcare professionals at
A&E.
If you are helping someone else, wear appropriate protective clothing, then:
remove any clothing that has the chemical on it from the person who has been burnt
if the chemical is dry, brush it off their skin
use running water to remove any traces of the chemical from the burnt area
Sunburn
In cases of sunburn, follow the advice below:
If you notice any signs of sunburn, such as hot, red and painful skin, move into the
shade or preferably inside.
Take a cool bath or shower to cool down the burnt area of skin.
Apply after-sun lotion to the affected area to moisturise, cool and soothe it. Do not
use greasy or oily products.
If you have any pain, paracetamol or ibuprofen should help relieve it. Always read the
manufacturers instructions and do not give aspirin to children under 16 years of age.
Stay hydrated by drinking plenty of water.
Watch out for signs of heat exhaustion or heatstroke, when the temperature inside
your body rises to 3740C (98.6104F) or above. Symptoms include dizziness, a
rapid pulse or vomiting.
If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has
their clothing loosened, they should start to feel better within half an hour. If they dont, they
could develop heatstroke. This is a medical emergency and youll need to call 999 for an
ambulance.
Read more information about the complications of burns and scalds.
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Recovery
How long it takes to recover from a burn or scald depends on how serious it is and how it is
treated. If the wound becomes infected, seek further medical attention.
Burns that don't need medical attention
If your burn or scald is mild and treated at home, it should heal without the need for further
treatment. Read more about how to treat burns and scalds.
Keep the burn clean and do not apply any creams or greasy substances. Do not burst any
blisters because this can lead to infection.
If you have scalded the inside of your mouth by drinking something hot, try to avoid things
that can irritate the scalded area, such as hot and spicy food, alcohol and smoking, until the
area heals.
Mild burns or scalds that only affect the uppermost layer of skin (superficial epidermal burns)
will usually heal in about a week without any scarring.
Burns that need medical attention
If you have a burn or scald that requires medical treatment, it will be assessed to determine
the level of care required.
The healthcare professional treating you will:
assess the size and depth of the burn by examining the area
clean the burn, being careful not to burst any blisters
cover the burn with a sterile dressing, usually a pad and a gauze bandage to hold it in
place
offer you pain relief if necessary (usually paracetamol or ibuprofen)
Depending on how the burn happened, you may be advised to have an injection to prevent
tetanus (a condition caused by bacteria entering a wound). For example, a tetanus injection
may be recommended if there is a chance that soil has got into the wound.
Your dressing will be checked after 24 hours to make sure there are no signs of infection. It
will be changed after 48 hours, and then every three to five days until it is completely healed.
Minor burns affecting the outer layer of skin and some of the underlying layer of tissue
(superficial dermal burns) will normally heal in around 14 days, leaving minimal scarring.
If the burn is severe, you may be referred to a specialist. In some cases, it may be necessary
to have surgery to remove the burnt area of skin and replace it with a skin graft taken from
another part of your body.
More severe and deeper burns can take months or even years to fully heal, and will usually
leave some visible scarring.
Exposure to the sun
During the first few years after your burn, you should try to avoid exposing the damaged skin
to direct sunlight as this may cause it to blister. It is especially sensitive during the first year
after the injury. This also applies to a new area of skin after a skin graft.
It is important to keep the area covered with cotton clothing. If the burn or scald is on your
face, wear a peaked cap or wide-brimmed hat when you're out in the sun. Total sun block, for
example one with a sun protection factor (SPF) of 50, should be used on all affected areas.
The area can be exposed to sunshine again around three years after the injury, but it is still
very important to apply a high-factor suncream (SPF 25 or above) and stay out of the midday
sun.
Blisters
Expert opinion is divided over the management of blisters that are caused by burns. However,
it is recommended that you should not burst any blisters yourself.
If your burn has caused a blister you should seek medical attention. The blister will probably
remain intact, although some burns units at hospitals follow a policy of de-roofing blisters.
De-roofing means removing the top layer of skin from the blister.
In some cases, a needle may be used to make a small hole in the blister to drain the fluid out.
This is known as aspiration and may be carried out on large blisters or blisters that are likely
to burst.
Your healthcare professional will advise you about the best way to care for your blister and
what type of dressing you should use.

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Complications
Complications from burns and scalds can include:
going into shock
heat exhaustion and heatstroke
infection
scarring
Shock
After a serious injury, it is possible to go into shock. Shock is a life-threatening condition that
occurs when there is an insufficient supply of oxygen to the body. It's possible to go into
shock after a serious burn.
Signs and symptoms of shock include:
a pale face
cold or clammy skin
a rapid pulse
fast, shallow breathing
yawning
unconsciousness
Dial 999 and ask for an ambulance if you think that someone who has been seriously injured
is going into shock.
While you wait for the ambulance:
lay the person down (if their injuries allow it) and raise and support their legs
use a coat or blanket to keep them warm, but do not cover their face or the burnt area
do not give them anything to eat or drink
Heat exhaustion and heatstroke
Heat exhaustion and heatstroke are two heat-related health conditions that happen when the
temperature inside your body rises to 3740C (98.6104F) or above.
Both heat exhaustion and heatstroke can be very serious. They are often caused by being
exposed to too much sunlight or heat.
Symptoms of heat exhaustion and heatstroke include:
extreme tiredness and lack of energy
dizziness or fainting
feeling sick or vomiting
rapid pulse
headache
muscle pain
irritability
confusion
If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has
their clothing loosened, they should start to feel better within half an hour. If they dont, they
could develop heatstroke. This is a medical emergency and youll need to call 999 for an
ambulance.
Read more about what to do if someone has heat exhaustion or heatstroke.
Infection
Wounds can become infected if bacteria get into them. If your burn or scald has a blister that
has burst, it may become infected if it is not kept clean. Seek medical attention for any burn
that causes a blister.
Your wound may be infected if:
it is uncomfortable, painful or smelly
you have a high temperature of 38C (100.4F) or higher
you have signs of cellulitis, a bacterial infection that causes redness and swelling of
the skin
Seek immediate medical attention if you think your burn has become infected. An infection
can usually be treated with antibiotics and painkilling medication, if necessary.
Scarring
A scar is a patch or line of tissue that remains after a wound has healed. Most minor burns
only leave minimal scarring. You can try to reduce the risk of scarring after the wound has
healed by:
applying an emollient, such as aqueous cream or emulsifying ointment, two or three
times a day
using sunscreen with a high sun protection factor (SPF) to protect the area from the
sun when you are outside.
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Prevention
Many severe burns and scalds affect babies and young children. The following advice can
help reduce the chances of your child having a serious accident.
In the kitchen
it's best to keep your toddler out of the kitchen, well away from kettles, saucepans and
hot oven doors you could put a safety gate across the doorway to stop them getting
in
use a kettle with a short or curly cord to stop it hanging over the edge of the work
surface, where it could be grabbed
when cooking, use the rings at the back of the cooker and turn saucepan handles
towards the back so your child can't grab them
In the bathroom
never leave a child under five alone in the bath, even for a moment
fit a thermostatic mixing valve to your bath's hot tap to control the temperature
put cold water into the bath first, then add the hot water use your elbow to test the
temperature of the water before you put your baby or toddler in the bath
Throughout the home
put your iron, hair straighteners or curling tongs out of reach while they cool down
after you have finished using them
fit fireguards to all fires and heaters
keep matches, lighters and lit candles out of young children's sight and reach
Hot drinks
keep hot drinks well away from young children a hot drink can still scald 20
minutes after it was made
put hot drinks down before you hold your baby
after warming a bottle of milk, shake the bottle well and test the temperature of the
milk by placing a few drops on the inside of your wrist before feeding it should feel
lukewarm, not hot
don't let your child drink a hot drink through a straw
Preventing sunburn
encourage your child to play in the shade (under trees, for example) especially
between 11am and 3pm, when the sun is at its strongest
keep babies under the age of six months out of direct sunlight, especially around
midday
cover your child up in loose, baggy cotton clothes, such as an oversized T-shirt with
sleeves
get your child to wear a floppy hat with a wide brim that shades their face and neck
cover exposed parts of your child's skin with sunscreen, even on cloudy or overcast
days use a sunscreen that has a sun protection factor (SPF) of 15 or above and is
effective against UVA and UVB
reapply sunscreen often throughout the day